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<br /> PERMIT APPLICA�I�N �
<br /> BUILDING /MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov( www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS. VD PROPERTY TAX#: G► �/�
<br /> -v l v
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br /> � _ �� _ . GONTACT,INF� NIATI�31+1 , ' ° i� `
<br /> ��t� ��>;i � � ,r �� ��� �,'
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ,V �
<br /> � CIIY � fI STATE ZIP
<br /> OWNER PHONE: 2, "' OWNER EMAIL: ` , �
<br /> CONTRACTOR NAME;
<br /> CONTRACTOR ADDRESS: sraeer � �
<br /> � CI1Y .'� � � STATE ZIP � 1
<br /> CONTRACTOR PHONE: L — "— CONTRACTOR EMAIL: � / /
<br /> CONTRACTOR LICENSE#(REQUIRED): Lv(���� ���Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)•
<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) �
<br /> CONTACT AME: CONTACT PHONE: y " �
<br /> .
<br /> CONTACT EMAIL: ' �
<br /> : �!��ai.,��'i�;M'rytliii ��'�� i�a 'a���:= _ �it�i��. i� _ ■ yi,�ra-.;�. �+ =�y„o;y _� �y �.:���-.�. }��- ;�.;:��+i� �-;- �r in i,�p„"��s- ,.�L,y., ,�,t :i` � i�;:i� .
<br /> 3�iiu�illll�Il) . �NPaI!!!�ill� ��'Iiv;�it�;�"�Fs,`�,�Ai'��Inae� ���,�.i �';��q����1W� «w��t��t!F�:I�a��l;'���§!"��17 ;ih-: '� '�" ' .,, �� :a: ��il�i i�) ,r,'
<br /> t � ..._ap..a. __ II ��� ,hr � -d ��,� . ����i >
<br /> Existing Use of Building: Contract Price of Work:$ �
<br /> Proposed Use of Bui►ding: Heat Source: , as ❑Electric ❑Other
<br /> Building Type: SFR-D tac ed ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Pro'ect: ❑New ddition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK: ` � � �� �^ �� � ,I�n���
<br /> �: i\�- �l� � nC� �tN1'1 C-� � o�" Y z � � ;
<br /> � ��
<br /> ASSOCIATED BUILDING PERMIT# if a plicable :
<br /> f�r_�',,,r MEG�lA�11Cl�L P,E�M1T A�PLICATI�ON, ���,,. ��„::�.' PLUNIB�NG PER�11��'�A��L1CpT10N
<br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn Alteration _Repair
<br /> #of List of Fixtures #oi List of Flxtures #of ist of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet Backflow enter(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Uri
<br /> Gas Piping Boiler � Lavatory ash Basin) nnking Fountain
<br /> R Water Heater Refrigeration Shower � Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher of Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medi Gas
<br /> Range Hood Water Heate Other:
<br /> Exhaust Fan Sink(Serv' r/Mop/etc. Other:
<br /> ������;����'�P�u��L�R,��31j���RESSI��N�SYS"��M��1��'"',
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is frue and correct.Work done pursuant to this permlt must comply with
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no devia�ions therefrom.Deviations must first be authorized in wrfting from the
<br /> Building OHicial before being authorized under any circumsiance.1 am the owner,or I am authorized by the owner of this pioperry to perform the work for which application is made,
<br /> nd I comply with the St e Contra tors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use ONy
<br /> PERMIT
<br /> ! 2�! � ! �M �Q,6G -- d'1.�
<br /> Ovyner ori e ent Sign e Date j (Revised 10/12/2015)
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